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Do You Have Shoulder Pain? Here's a good place to Start

guss

guss

MuscleHead
Aug 11, 2010
380
179
#1
The shoulder joint is the most delicate joint in the body. Why? Is has 360 degree range of motion and is not protected by many bones or ligaments. Your humeral head (arm bone) sits in a very small recess called the glenoid fossa. The glenoid fossa is made a little larger by a rim of cartlidge called the glenoid labrum. The joint is maily supported by the rotator cuff, rhomboids, serratus anterior, some ligaments and the joint capsule.

The more info you can give us about your injury, the more we can help. BMJ has a post, about last October, where he went to some old threads and got all the questions and special tests that have been asked before and answered them when he was asking us about his shoulder. That rocked and made our job easier.

A good start is:

Any noticeable imbalances? Anything else cause the pain? Was it a sudden onset (acute episode) or more gradual? Does it get better when you warm-up? Hurt more when cold (like when you get up)? Does it hurt before activity, during activity, and/or after activity. Does it hurt on contraction and/or stretch? Does it hurt on both sides? Can you palpate (poke with your finger) the pain?

Many times, whenever someone has tendonitis, they are diagnosed with impingement (but the two really go hand in hand) What does this mean? The rotator cuff failed to stabilize the shoulder (humeral head of arm) and it clunks around - jamming up on the acromion/clavicular joint, slamming the supraspinatus tendon in between. This is not neceassarily a surgery condition, unless you have a hooked acromion on a really decreased space. When someone has rotator tendonitis(supra),the A/C space is compromised, so they will almost always test postive for primary impingement.When they do surgery, they perform a sub acromial decompression. Bascially they widen the space under the A/C. But, many times all this does it give the person more room to "clunk" around in. If you have no associated rotator or labrum tears and have a somewhat normal acromial space and acromion, let the area (supra) "calm down" and hit the rotator cuff exercises hard.

Why did you get tendonitis in the first place? Many of us have tight internal rotators (pec/front delts) which can put abnormal stress on the shoulder. You can do the normal pec/fron delt stretches, but the best stretch I have found is overhead squats with a PCV pipe or something similar. Not only will it stretch out those pecs/shoulder, but also your back and hips.

Some may have some imbalances from to high a volume of pressing movements (or higher intensity) compared to pulling movements. A great way to work the shoulder stabilizers is to do dead lifts or even RDLs. ANd pinching the shoulder blades together during rows and pulldowns will stress the rhomboids, which stabilize the shoulder (and you will get the added benfit of not walking around like a caveman!)

Some may have weak shoulder stabilizers (supra, ext rotators, rhomboids, serratus anterior). Do a lot of pressing movements, these muscles start to fail and then you get the clucking around of that humeral head again which irritates the tendon.

You ever see someone have one shoulder “pop up” when pressing or working the chest? Well, then the full force of supporting the joint is falling on the rotator cuff. Do that enough and you are screwed. Always try to perform exercises in chest out shoulder down position. If you “loose” that form, terminate the set. Also goes for getting those “last reps.” Stop the set and live to fight another day.

If you have a torn labrum or rotator cuff (usually the supra) this area will almost surely not heal on its on. You can do all the rehab in the world, but if the pain is very bad, about the only solution is to get them scoped. The ortho would go in and trim out the defects and clean up the area. You can be lifting normal in 6-8 weeks. All people I know who have had their shoulder scoped due to this condition are very happy afterwards and wished they did not wait. The same is true for a "hooked" acromion process that is digging into your supra. Get that bad boy shaved down and you will be a happy camper.

I do not like or dislike the use of cortisone shots. I think they can be used, if used correctly. We often are chronically inflamed for months. In some cases the inflammation just won’t go away. Get the shot and then do the rehab and stretching and stick with it. The problem is, someone will often get injected, then go back to the same routine with no attention to the rehab, and screw themselves again.

And remember, you do not have to perform a movement. As the ortho I worked with always said “we all come out of the factory differently.” An exercise may just not be suited for your body type or maybe you did hurt the joint/muscle in the past and have some scar tissue or arthiritis. Find a different angle, grip, or exercise to work the body part.

I like the Cuban press with Dbs, but you can just rotate but not press. Many people will have you just do “isolation” type rehab exercises (for ext rotator and supra),while those certainly can be performed, I favor more integrated movements, like the Cuban press. Note that you cannot perform these movements if still inflamed or in pain, esp the integrated movements.

I like the “reverse throw” movement. You can do with a band or pulley. Think of a pitcher in throwing in reverse (with no stepping or hip rotation).
 
TheClap

TheClap

VIP Member
Oct 25, 2011
507
129
#3
If you have a torn labrum or rotator cuff (usually the supra) this area will almost surely not heal on its on. You can do all the rehab in the world, but if the pain is very bad, about the only solution is to get them scoped. The ortho would go in and trim out the defects and clean up the area. You can be lifting normal in 6-8 weeks. All people I know who have had their shoulder scoped due to this condition are very happy afterwards and wished they did not wait. The same is true for a "hooked" acromion process that is digging into your supra. Get that bad boy shaved down and you will be a happy camper.
Thank you for this information right here. I have a torn labrum in my left shoulder that never bothers me anymore because I babied it for years. Recently had an injury to my other shoulder at work that feels exactly the same. Haven't gotten the MRI done yet but was trying to decide if I should get the surgery if it turns out I tore this one too. Even on the company's dime it's surgery. It's a big decision, but this here really helps put my mind at ease. I have the spurs in my acromio-clavicular joint on the left too that the ortho said he would shave down. Glad to hear others have had such good results.
 
Blacken

Blacken

Senior Member
Sep 6, 2013
212
40
#5
Very good read.

And I truly believe this goes along with all exercises.

"And remember, you do not have to perform a movement. As the ortho I worked with always said “we all come out of the factory differently.” An exercise may just not be suited for your body type or maybe you did hurt the joint/muscle in the past and have some scar tissue or arthiritis. Find a different angle, grip, or exercise to work the body part."
 
woodswise

woodswise

TID Board Of Directors
Apr 29, 2012
4,116
1,045
#6
I occasionally have shoulder pain. I have discovered that if I press down on the top of the joint and rotate my shoulder that the pain lessens. It is almost as though the tendons / joint gets inflamed, and the pressure lowers the inflammation. After just a few days of doing this, the pain goes away and does not return quickly.

Rotator exercises help, too.
 
Blacken

Blacken

Senior Member
Sep 6, 2013
212
40
#7
Another thing which I failed to mention work on your rear delts. So many people tend to overdevelop the front delt and side delts. The should joint is the weak if one of your delts is underdeveloped there goes the balance of the shoulder girdle.
 
kid666

kid666

VIP Member
Jan 28, 2011
1,450
502
#8
Good stuff..my right shoulder kills me every morning...lots of pain...when im sleeping if its over my head and I wakeup I literally have to
use my other arm to help lower it cause of the pain..but most times during the day when ive been up a few hours it feels fine..
 
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